Lead Coder, Outpatient Health Information Management - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Lead Outpatient Medical Coder

The Lead Outpatient (OP) Medical Coder assists the HIM OP Coding Manager with administrative functions specific to all outpatient coding operations. Duties may be varied and may include many of the following: assisting the OP Coding Manager to organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of production-coder performance, develop and implement quality improvement activities, train and mentor staff, provide feedback coding error findings and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. The Lead OP Medical Coder is responsible for serving as a subject matter expert in coding processes, providing advanced technical guidance, and ensuring coding accuracy, compliance, and productivity standards are met. The position supports coders and auditors through consultation, mentoring, and expertise on complex coding scenarios, and is responsible for the assisting the OP Coding manager with the quality of coding outpatient data in accordance with all medical coding laws, rules, regulations, and regulations. Provide coding liaison functionalities between HIM Coding and other Revenue Cycle Depts., including Patient Financial Services (PFS) regarding OP claims rejection/denial management and coding-related edits, items, and issues. Perform assorted OP coding auditing functions.

Essential Duties:

• Assists the HIM Outpatient (OP) Coding Manager with various coding-related administrative RevCyc functions specific to outpatient coding operations.
• Serve as a resource and consultant for coders on complex or specialty coding scenarios.
• Review and provide guidance on challenging cases to ensure coding accuracy and compliance. Partner with auditors to resolve discrepancies and identify trends in coding errors.
• Provide mentoring and technical support to coders, promoting knowledge sharing and best practices.
• Assist in developing and updating coding procedures, guidelines, and reference materials.
• Collaborate with clinical, billing, and Revenue Cycle Management (RCM) teams to clarify documentation and optimize coding accuracy.
• Monitor coding metrics and provide feedback on efficiency, productivity, and quality.
• Participate in education sessions, audits, and case reviews to support continuous improvement.
• Serve as a liaison between coders, auditors, and management to resolve workflow and compliance issues.

Coding-Related Billing System Edits, Charge Review, and Correction:

• Work coding-related billing system edits, soft-coded charge reviews, and denial work queues/worklists.
• Monitor coded encounters to ensure timely completion and that charges support optimal, compliant reimbursement.
• Communicate with appropriate staff, including Patient Financial Services, to resolve issues encountered during coding.
• Adhere to the Standards of Ethical Coding as established by AHIMA and follow official coding guidelines.
• Query physicians when documentation is incomplete, unclear, or ambiguous for accurate code assignment.
• Resolve National Correct Coding Initiative (NCCI) edits and other coding edits in accordance with current LCDs, NCDs, and CMS guidance.

OP Coding Educator:

• Develop and maintain a consistent coding operations orientation program and report coder progress to Coding Leadership throughout training.
• Analyze clinical documentation for quality and completeness, providing education, feedback, and oversight to Medical Coding Specialists.
• Orient new coding staff on the department's role in the revenue cycle and prepare training materials for coding-related education.
• Develop education materials based on audit findings and review them with coding staff and key stakeholders.
• Assist coding leadership with training and the development of performance improvement plans related to quality or productivity concerns.
• Serve as a subject matter expert on official coding guidelines. Organize and conduct monthly individual and team training sessions and meetings.
• Monitor changes in coding methodologies, official guidelines, regulatory standards, and reimbursement structures.
• Analyze the impact of coding and clinical documentation on reimbursement and identify opportunities for improvement.

OP Coding Editor Program, Functions, & Team:

• Support the Coding Editor team in resolving post-coding, pre-bill edits identified in billing and clearinghouse systems.
• Assist in denial prevention strategies, processes, and workflows by researching and resolving coding-related edits and issues.
• Address post-coding, pre-bill edits related to medical necessity and procedural documentation using OCE/NCCI edits, CMS and MAC transmittals, Medicare Claims Processing Manuals, ICD-10-CM/PCS, CPT/HCPCS, and modifier guidelines.
• Collaborate with Patient Financial Services (PFS), HIM Coding Support, and Clinical Documentation Integrity (CDI) teams to resolve documentation and medical necessity issues.

Regulatory, Coding, & Clinical Research:

• Maintain strong knowledge of legal, regulatory, and compliance requirements related to coding and documentation.
• Conduct in-depth research using authoritative sources such as IPPS/OPPS Federal Register, NCDs, LCDs, NCCI edits, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant.
• Ensure all work complies with federal and state laws, regulations, and payer policies.
• Apply regulatory guidance to support and defend coding decisions during audits and payer disputes.

Root Cause Analysis & Process Improvement:

• Utilize research skills and analytical tools to resolve complex coding and healthcare issues.
• Identify and trend recurring denial patterns and DRG downgrades.
• Conduct root cause analyses to determine systemic issues related to coding, documentation, or workflow.
• Develop and recommend corrective action plans in collaboration with coding, billing, CDI, and clinical teams.
• Support documentation improvement initiatives by initiating CDI queries when clarification is needed.

Communication & Collaboration:

• Serve as a liaison among coders, clinicians, CDI specialists, billing teams, PFS, and external payers.
• Demonstrate strong written, verbal, and presentation skills when communicating audit findings, risks, and compliance issues.
• Communicate professionally and effectively with internal stakeholders and external partners.
• Provide timely follow-up through written and verbal communication, including emails, documentation, and discussions.
• Maintain strong, ethical, and solution-focused relationships with coding leadership and cross-functional teams.

Information Systems & Technology:

• Utilize and navigate EHR and coding systems effectively, including:
• Cerner/PowerChart and Coding mPage
• Solventum/3M 360 Encompass (CAC/CRS)
• Solventum/3M HDM, HRM, and ARMS
• Soarian Financials and CHC Assurance PFS systems
• Leverage system tools and embedded references to support accurate coding, denial resolution, and appeals processing.
• Adhere to AHIMA's Standards of Ethical Coding and official coding guidelines.

Perform other duties as assigned.

Required Qualifications:

• Req Bachelor's Degree Health Information Management (HIM), or Health Information Technology (HIT), or Health Information Systems (HIS)
• Req Specialized/technical training Successful completion of college courses in Medical Terminology, Anatomy & Physiology and a certified coding course. Successful completion of the hospital specific coding test with a passing score of ?85%. The coding test may be waived for former USC or agency/contract HIM Coding Dept. coders who historically/previously met the ? 90% internal/external audit standards of the previously held USC Job Code.
• Req 5-10 years Experience in ICD-10-CM, ICD-10-PCS, CPT/HCPCS coding of inpatient & outpatient medical records in an acute care facility.
• Req Experience in using a computerized coding & abstracting database software and encoding/code-finder systems [e.g., 3M 360 Encompass/CAC and 3M Coding and Reimbursement System (CRS)].
• Req Working knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, MS-DRG, APR-DRG coding principles.
• Req Organization/time management skills.
• Req Demonstrate excellent customer service behavior.
• Req Demonstrates excellent verbal and written communication skills.
• Req Able